In our attempt to document gonadal dysfunction in uremia and to determine its pathogenesis (with special emphasis on evaluation of the integrity of the hypothalamo-pituitary axis in uremia), we have collected sufficient data to show that there is a prevalence of gonadal damage in uremic adults. We intend to study the sexual development of children undergoing maintenance hemodialysis and will use the staging of puberty by Tanner's criteria and measurements of plasma levels of gonadal (testosterone or estrogen and progesterone) and adrenal (dehydroepiandrosterone) steroids and gonadotropins. The gonadotropin response to clomiphene citrate in these children will also be assessed. The results will be correlated to bone age, growth velocity, and nutritional intake. We also intend to study, in detail, the neuroendocrine control of ovulation in women with chronic renal failure. We specifically intend to study the negative feedback as well as the positive feedback of estrogen on the hypothalamo-pituitary axis by assessing gonadotropin responses to clomiphene and estrogen administration. Normal women will be studied in a similar fashion for comparison. Additionally, we are planning to assess and compare the effect of clomiphene citrate and exogenous testosterone supplementation on sexual and endocrine function.